Psychological Issues in Patients With Primary HIV Infection

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Individuals who learn they are infected with HIV -- whether chronically or acutely -- commonly experience a range of emotions including:

anger

confusion

anxiety

shame, guilt, or alienation

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sadness or depression

The psychological impact of such feelings can be profound, and referral to a counselor or therapist experienced with HIV disease is recommended. In particular, depression is the most common psychiatric disorder among HIV-infected patients and pharmacological intervention may be warranted.

Persons diagnosed with primary HIV infection (PHI) are faced with psychological challenges unique to their early disease stage. A PHI patient presenting with symptoms such as fevers, rash, or diarrhea may confuse these symptoms with those of AIDS. Patients with PHI should first be assured that they do not have AIDS and that PHI is an early disease stage after which many people remain healthy for 10 years or longer, even without treatment. Additionally, treating factors that may have contributed to infection (for instance, alcohol, drug, or sexual addiction) can help reduce further transmission, especially during such an episode of high viremia as found in PHI.

Of equal concern, especially if the clinician decides to initiate antiretroviral therapy during PHI, is that patients understand why they will be taking potent drugs to fight HIV when most chronically infected people are advised to wait until mid- or late-stage disease before starting therapy. An essential issue is whether or not patients should be enrolled into clinical study, if available. Each patient should be counseled about the pros and cons of such enrollment. Also, issues regarding potential drug side effects and toxicities, as well as the importance of adherence, should be explained.

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